Structured Exercise Program After Adjuvant Chemotherapy for Colon Cancer: A Cost-Utility Analysis of the CHALLENGE Trial
Abstract
PURPOSE The phase III CHALLENGE trial (CCTG CO.21) demonstrated that a 3-year structured exercise program (SEP) improved disease-free and overall survival versus health education materials (HEM) in patients with stage III or high-risk stage II colon cancer after surgery and adjuvant chemotherapy. We assessed the cost-effectiveness of the SEP versus HEM. METHODS This prespecified economic evaluation used prospectively collected data from all trial participants (N = 889). The base case adopted the Canadian public payer perspective and included direct health care costs over a 5-year time horizon with a 1.5% discount rate. 36-Item Short Form (SF-36) outcomes were mapped to Short-Form 6-Dimension (SF-6D) utilities using a validated algorithm. Mean costs (2024 in Canadian dollars [CAD]) and effects (life-years [LYs] and quality-adjusted LYs [QALYs]) per participant in each intervention group were used to estimate the incremental costs, incremental LYs/QALYs, incremental cost-effectiveness ratio (ICER, $ CAD/life-year gain [LYG]), and incremental cost-utility ratio ($ CAD/QALY) when applicable. Uncertainty was assessed via bootstrapping (1,000 samples). Notable scenario analyses included a 10-year time horizon and a societal perspective incorporating lost wages because of missed work, measured through the Work Productivity and Activity Impairment questionnaire. RESULTS In the base case, despite an up-front cost of $2,917 (CAD)/participant to provide the SEP, the SEP strategy (total cost: $31,957 (CAD)/participant) was dominant over HEM (total cost: $33,546 (CAD)/participant), being less costly (-$1,589/participant) and more effective (+0.05 LYs/participant; +0.10 QALYs/participant). The SEP was dominant in 53% of bootstrap samples, and 80% fell below a $50,000 (CAD) per QALY willingness-to-pay threshold. Major cost drivers were cancer recurrence or new malignancy and anticancer therapy. Scenario analyses were consistent with the base case. CONCLUSION The SEP was less costly and more effective than HEM. This study can inform payers and health systems with implementation of SEPs in routine care.
Article Details
Journal Info
Journal of Clinical Oncology
Lippincott Williams & Wilkins
Authors (184)
Kelvin K.W. Chan
Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
Ryan W.K. Chu
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
Matthew C. Cheung
Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Kerry S. Courneya
Christopher J. O'Callaghan
Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
Janette L. Vardy
Faculty of Medicine and Health, University of Sydney, Sydney
Sharlene Gill
BC Cancer–Vancouver, Vancouver, BC, Canada
Christine Friedenreich
Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Rebecca K.S. Wong
Princess Margaret Cancer Centre, University Health Network, Department of Radiation Oncology, University of Toronto, Toronto
Haryana M. Dhillon
Faculty of Science, Psycho-Oncology Cooperative Research Group, School of Psychology, University of Sydney, Sydney
Victoria Coyle
Queen’s University Belfast, Belfast, United Kingdom
Neil Sun Chua
Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
Derek J. Jonker
Ottawa Hospital Research Institute, University of Ottawa, Ottawa
Ralph M. Meyer
Department of Oncology, McMaster University, Hamilton, ON, Canada
Shahid Ahmed
John Raymond Zalcberg
Department of Medical Oncology, Alfred Health and School of Public Health, Faculty of Medicine, Monash University, Melbourne, VIC, Australia
Stephen John Clarke
University of Sydney, Sydney, NSW, Australia
Patti O'Brien
Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
Patricia A. Tang
Arthur J.E. Child Comprehensive Cancer Centre, University of Calgary, Calgary, AB, Canada
Ralph Wong
CancerCare Manitoba, St. Boniface General Hospital, Winnipeg, Canada
Howard J. Lim
BC Cancer–Vancouver, Vancouver, BC, Canada
Matthew E. Burge
Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
Michael Brundage
Department of Oncology, Queen’s University, Kingston, ON, Canada
Annette E. Hay
Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
Dongsheng Tu
Canadian Cancer Trials Group, Queen’s University, Kingston, ON, Canada
Christopher M. Booth
Department of Oncology, Queen’s University, Kingston, ON, Canada
Kate Mahon
Philip Beale
Lisa Horvath
David Goldstein
Stephen Clarke
Nick Pavlakis
Gavin Marx
Connie Diakos
Mustafa Khasraw
Annabel Goodwin
Prunella Blinman
Weng Ng
Ray Asghari
Winston Liauw
Katrin Sjoquist
Fiona Abell
Stephen Ackland
Antonino Bonaventura
Girish Mallesara
Andre Van Der Westhuizen
Maria Aslam
Lindy Turner
James Lynam
Robin Paterson
Mathew George
Sunil Rai
Stephen Begbie
Karen Briscoe
Lorraine Chantrill
Aflah Roohullah
Abiramy Ragunathan
Stephanie Lim
Steven Della-Fiorentina
Melissa Moore
Bhaumik Shah
Fox Chase Cancer Center
Stephen Brown
Mahesh Iddawela
Monash University Faculty of Medicine, Nursing, and Health Sciences, Melbourne, VIC, Australia
Zeewan Wong
Babak Tamjid
David Wyld
Alison M. Hadley
Melissa Eastgate
Jeffrey C.H. Goh
Nimit Singhal
Tim Price
Chris Karapetis
Shawgi Sukumaran
Thomas Ferguson
M. Saleem Raza
Margot Burnell
Anthony J. Reiman
Samantha Gray
James Michael
1Thomas Jefferson University, The Cardeza Foundation for Hematologic Research, Center for Hemostasis, Thrombosis and Vascular Biology, Department of Medicine, Philadelphia, United States
Sheldon Rubin
Mohammed Harb
Mahmoud Abdelsalam
Felix Couture
James Biagi
Anna Tomiak
Chris Booth
Nazik Hammad
Heather Ann Ostic
Tim Asmis
Christine Cripps
Rachel Goodwin
Tina Hsu
Michael Vickers
Radhika Yelamanchili
3McMaster University, Medicine, Hamilton, Canada
Philip F.D. Hughes
Brian Findlay
David Wasserman
Linda M. Lee
Cameron Phillips
Elaine McWhirter
Brandon M. Meyers
Sukhbinder Dhesy-Thind
John Goffin
Kevin Zbuk
Kathryn Towns
Peter James Anglin
Ronald L. Burkes
Yoo-Joung Ko
Scott Berry
Simron Singh
Mark Doherty
Kristy Wasson
Michael Jonathon Raphael
Eric (Xueyu) Chen
Mark Rother
Jeffrey Myers
2Nemours Children's Health, Wilmington, United States
Cindy L. Quinton
Leonard Kaizer
Stacey Hubay
Department of Oncology, Grand River Regional Cancer Centre, Kitchener, ON, Canada
Elaine Bouttell
Mala Bahl
Andrea Molckovsky
Grand River Regional Cancer Centre, Kitchener, ON, Canada
Mary DeCarolis
Mario Amilcar Valdes
Michael Sanatani
Division of Medical Oncology, Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
Stephen Welch
Mark D. Vincent
Mary J. MacKenzie
Karin Hahn
Joel Gingerich
Vallerie Gordon
Marianne Krahn
Paul Daeninck
Vamsee Torri
Christina Kim
Benjamin Adam Goldenberg
James T. Paul
A. Saranya Kakumanu
Haji Ibrahim Chalchal
Muhammad Salim
Osama Souied
Mussawar Iqbal
Kimberly M. Hagel
Nayyer Iqbal
Kamal Haider
Saskatoon Cancer Centre, University of Saskatchewan, Saskatoon, Canada
Dorie-Anna Dueck
Adnan Zaidi
Sasha Lupichuk
Vanessa Krause
Scot Dowden
Vincent Tam
Temple University, Lewis Katz School of Medicine
Jose Monzon
Jay Easaw
Richard Lee-Ying
Xiaolan Feng
Karen M. King
Sheryl Koski
Andrew G. Scarfe
Karen Mulder
Michael Sawyer
Julie A. Price Hiller
Jennifer Spratlin
Amelie Fontaine
3Cross Cancer Institute & University of Alberta, Edmonton, Canada
Judith Meza-Junco
Maria Ho
Kelvin Young
Barbara Lynn Melosky
Hagen Kennecke
Daniel John Renouf
Janine Davies
Jonathan M. Loree
Thibault Mazard
Emmanuelle Samalin
Marc Ychou
Fabienne Portales
Ann Thomas
Richard Adams
Vanessa Porter
Alice Dewdney
Nirit Yarom
Stephen Bernard
Autumn McRee
Kathryn Hourdequin
Steven Keteyian
Division of Cardiovascular Medicine, Henry Ford Medical Group, Detroit, Michigan, United States